Health Imaging & IT - October 2007 - (Page 40) special section: Oncology Imaging UCSD recently installed Siemens’ INVISION Patient Care Solutions patient information system. That plays a role in reworking how these large datasets are archived. But with the massive amount of data, “now we have to keep better track of which patients are being imaged by which modality and of storage space on the local imaging device at the linear accelerator,” says DeMarco. Data growth is a constant IT issue but budgetary concerns haven’t been a problem for DeMarco—yet. “If we keep track of the storage problem and we add storage on an incremental basis, we have no problems getting the expenditure approved. If we wanted to make a large paradigm shift, like spend a lot of money on a new PACS for radiation therapy, that would be difficult.” Eventually, he says, radiation therapy will turn into a separate radiology department with large-scale storage issues. “Radiation therapy will need its own sophisticated PACS.” There are scheduling and other logistical issues to consider, but it might be cheaper and easier for a hospital to invest in a mini PACS and manage it on a local level. “I like the local solution myself, but is it cost effective? That’s hard to answer at this point.” more images, more storage The image volume required in oncology means more daily images and more work for physicians and physicists, says Jerome Landry, MD, a radiation oncologist at the Emory Winship Cancer Institute in Atlanta. The facility uses IMRT and IGRT equipment from Varian Medical Systems. When patients receive IMRT and IGRT therapy, images are checked daily or every other day. “At Emory, we track how well the physicians are doing with weekly checking. We typically run about 90 to 100 percent compliance.” They do have to spend extra time to be compliant, however. “From my point of view, the technology is so advanced that the 30 minutes added to my day to get online and look at these images is not that big of a deal when I consider that I’m hitting the tumor more accurately.” To help improve efficiency with extracranial stereotactic radiosurgery, Landry says the group has written a program called Aerial that allows for more accurate quality assurance of gantry angles and set-up precision. “When we do treatment, we can bring that data in quickly. That gives us more comfort with our treatment and helps us save time.” Aerial allows for quick treatment in critical situations at any site. “One can remotely look at images from multiple sites,” Landry says. “The patient doesn’t necessarily have to come back to Emory if something needs to be done immediately. I can visualize images online in real time.” St. Margaret Mercy Health Center in Hammond, Ind., uses a Kodak 2000RT CR Plus system from Carestream Health which offers an all-in-one CR solution for therapy, simulation and dosimetry imaging tracking changes Renate Muller-Runkel, MD, medical physicist at St. Margaret Mercy Health Center in Hammond, Ind., uses a Kodak 2000RT CR Plus system from Carestream Health which offers an all-in-one CR solution for therapy, simulation and dosimetry imaging. “Image management here is very important because it is of the utmost importance that the beam is in the right position,” she says. The team inputs all new patients’ digital reconstructed radiographs into the system. Then, once the patient is on the treatment table, the therapist takes the cine film, read in the Kodak system, and compares it side-by-side with the intended target. The 40 O C T O B E R 2 0 07 | Health Imaging & IT therapist can see how precise the beam positioning is—whether the target moved a half centimeter posteriorly or to the left or right. This process is done on a routine basis at least once a week, Muller-Runkel says, “so that we know our treatment is aimed exactly at the tumor.” Once a physician has requested a change in position, another image is taken the next day before turning on the beam. Patients typically get one portal image done per week. Many are undergoing IMRT treatments, but some undergo conventional 3D therapy. Muller-Runkel’s team of two physicians and five therapists treats about 25 patients a day. The hospital uses an electronic medical system so all data are stored redundantly and Muller-Runkel reports that the entire process has put an end to lost films. She says she prefers the Kodak system to the new linear accelerators that usually come with a portal imager. Her system offers a larger field size that can be captured on a flat panel imager and increased accuracy. She would like to get a second machine for another location but the budget may not allow for that just now. the last word Data storage requirements in oncology imaging are only going to increase. Each step taken to further imaging technology means larger datasets and more imaging. Vendors are aware of this and are working on more storage solutions to help providers keep up with the rapid growth. HealthImaging.com http://HealthImaging.com
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